(43) Baseline Study for Improving Diagnostic Stewardship at Secondary Health Care Facilities in Nigeria

Publication Number: 374

Background: Sub-Saharan Africa and South-East Asia contributes 85% of 48.9 million sepsis cases and 84.8% of 11 million related deaths reported globally. Blood culture diagnostics in suspected sepsis are often underutilised in low-resource settings such as Nigeria. This hinders effective pathogen identification, contributes to the spread of antimicrobial resistance and undermines efficient antimicrobial therapy.

Objectives: To assess reported sepsis case finding, factors associated with the use of blood culture diagnostics, and describe antimicrobial use at two secondary health care facilities

Methods: A cross‑sectional online survey was conducted among 25 public secondary health care facilities in Abuja, FCT and Lagos State in Nigeria to evaluate the capacity for pathogen identification and AST. Data were then prospectively extracted on patients with reported suspected sepsis from two healthcare facilities in Abuja from October 2020 to May 2021 to assess sepsis case‑finding, samples request and antimicrobial therapy. Data were descriptively analysed. A multivariate logistic regression analysis was conducted to determine factors associated with blood culture requests.

Results: In the online survey, 32% (8/25) of facilities reported performing blood cultures. Only one had access to a clinical microbiologist, and 28% (7/25) and 4% (1/25) used standard bacterial organisms for quality control of media and quality control strains for AST, respectively. At the two facilities where data abstraction was performed, 7.1% (2924/41066) of patients were found to have reported suspected sepsis. Majority of these patients came from the paediatrics department, were outpatients and the median age was two years. Most did not have vital signs or major foci of infection documented. Blood cultures were requested for 2.7% (80/2924) of patients. Inpatients (adjusted odds ratio [aOR]: 7.5, 95% CI: 4.6–12.3) and patients from the urban health care health facility (aOR:16.9, 95% CI: 8.1–41.4) were significantly more likely to have a blood culture requested. After consultation, more antibiotics in the Watch category (66.8%, 1628/2436) were prescribed for these patients compared to the Access category antibiotics (33.2%, 808/2436).

Conclusions: A significant number of of sepsis patients were in the paediatric age group with clinician suspicion used as principal tool for case finding. The use of blood culture for targeted therapy very poor and being an inpatient increased the odds of having a request. The use of Watch versus Access antibiotics increased, rising above the set target (60% for Access antibiotics). It is important to set up diagnostic stewardship programmes at these hospital to improve the detection and targeted treatment of sepsis.